Adaptive Weighted Error-Correction Method Based on the Error Distribution Characteristics of Multi-Channel Alignment

As process nodes of advanced integrated circuits continue to decrease below 10 nm, the requirement for overlay accuracy is becoming stricter. The alignment sensor measures the position of the alignment mark relative to the wafer; thus, sub-nanometer alignment position accuracy is vital. The Phase Grating Alignment (PGA) method is widely used due to its high precision and stability. However, the alignment error caused by the mark asymmetry is the key obstacle preventing PGA technology from achieving sub-nanometer alignment accuracy. This error can be corrected using many methods, such as process verification and multi-channel weighted methods based on multi-diffraction, multi-wavelength and multi-polarization state alignment sensors. However, the mark asymmetry is unpredictable, complex and difficult to obtain in advance. In this case, the fixed-weight method cannot effectively reduce the alignment error. Therefore, an adaptive weighted method based on the error distribution characteristic of a multi-channel is proposed. Firstly, the simulation result proves that the error distribution characteristic of the multi-alignment result has a strong correlation with the mark asymmetry. Secondly, a concrete method of constructing weight values based on error distribution is described. We assume that the relationship between the weight value of each channel and the deviations of all channels' results is second-order linear. Finally, without other prior process correction in the simulation experiment, the residual error's Root Mean Square (RMS) of fixed weighted method is 14.0 nm, while the RMS of the adaptive weighted method is 0.01 nm, when dealing with five typical types of mark asymmetry. The adaptive weighted method exhibits a more stable error correction effect under unpredictable and complicated mark asymmetry.

Relationships between muscle strength, lung function, and cognitive function in Chinese middle-aged and older adults: A study based on the China health and retirement longitudinal study (CHARLS)

OBJECTIVE

As the population ages, concerns about cognitive decline have become increasingly relevant in medical consultations. This study aims to analyze the interaction between muscle strength, lung function, and cognitive function in Chinese middle-aged and older adults, providing a theoretical basis for better prevention of cognitive decline.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) wave 3, including 13 716 participants aged 45 years or older. Cognitive function was assessed through two dimensions, resulting in a total score ranging from 0 to 31 points, with higher scores indicating better cognitive function. Muscle strength was measured using normalized grip strength and chair-standing time, while lung function was evaluated using peak expiratory flow (PEF).

RESULTS

Total cognitive function scores exhibited significant correlations with grip strength, chair-standing time, and PEF. Muscle strength and lung function demonstrated significant associations with cognitive function, with lung function emerging as a notable mediating factor. This relationship persisted even after adjusting for potential confounding variables. Specifically, PEF played a substantial mediating role in linking grip strength to cognitive function scores (estimated indirect effect = 0.0132, boot-strapped standard error = 0.0015, boot-strapped standard 95% confidence interval = 0.0104, 0.0162). Additionally, PEF served as a significant mediator in the association between chair-standing time and cognitive function scores (estimated indirect effect = -0.0204, boot-strapped standard error = 0.0023, boot-strapped standard 95% confidence interval = -0.0251, -0.0159).

CONCLUSION

The study highlights the importance of addressing declines in muscle strength and lung function to identify risk factors associated with cognitive function. Understanding these relationships can provide insights into potential pathways linking these variables and may aid in better prevention of cognitive decline. Further long-term longitudinal cohort studies are needed to explore the causality between these factors.

[Dynamic observation on capillarization of liver sinusoidal endothelial cells induced by Echinococcus multilocularis infection]

OBJECTIVE

To investigate the capillarization of liver sinusoidal endothelial cells (LSECs) and its association with hepatic fibrosis during the development of alveolar echinococcosis, so as to provide the basis for unraveling the mechanisms underlying the role of LSEC in the development and prognosis of hepatic injuries and hepatic fibrosis caused by alveolar echinococcosis.

METHODS

Forty C57BL/6 mice at ages of 6 to 8 weeks were randomly divided into a control group and 1-, 2- and 4-week infection groups, of 10 mice in each group. Each mouse in the infection groups was intraperitoneally injected with 2 000 Echinococcus multilocularis protoscoleces, while each mouse in the control group was given an equal volume of phosphate-buffered saline using the same method. All mice were sacrificed 1, 2 and 4 weeks post-infection and mouse livers were collected. The pathological changes of livers were observed using hematoxylin-eosin (HE) staining, and hepatic fibrosis was evaluated through semi-quantitative analysis of Masson's trichrome staining-positive areas. The activation of hepatic stellate cells (HSCs) and extracellular matrix (ECM) deposition were examined using immunohistochemical staining of α-smooth muscle actin (α-SMA) and collagen type I alpha 1 (COL1A1), and the fenestrations on the surface of LSECs were observed using scanning electron microscopy. Primary LSECs were isolated from mouse livers, and the mRNA expression of LSEC marker genes Stabilin-1, Stabilin-2, Ehd3, CD209b, GATA4 and Maf was quantified using real-time fluorescence quantitative PCR (qPCR) assay.

RESULTS

Destruction of local liver lobular structure was observed in mice 2 weeks post-infection with E. multilocularis protoscoleces, and hydatid cysts, which were surrounded by granulomatous tissues, were found in mouse livers 4 weeks post-infection. Semi-quantitative analysis of Masson's trichrome staining showed a significant difference in the proportion of collagen fiber contents in mouse livers among the four groups (F = 26.060, P < 0.001), and a higher proportion of collagen fiber contents was detected in mouse livers in the 4-week infection group [(11.29 ± 2.58)%] than in the control group (P < 0.001). Immunohistochemical staining revealed activation of a few HSCs and ECM deposition in mouse livers 1 and 2 weeks post-infection, and abundant brown-yellow stained α-SMA and COL1A1 were deposited in the lesion areas in mouse livers 4 weeks post-infection, which spread to surrounding tissues. Semi-quantitative analysis revealed significant differences in α-SMA (F = 7.667, P < 0.05) and COL1A1 expression (F = 6.530, P < 0.05) in mouse levers among the four groups, with higher α-SMA [(7.13 ± 3.68)%] and COL1A1 expression [(13.18 ± 7.20)%] quantified in mouse livers in the 4-week infection group than in the control group (both P values < 0.05). Scanning electron microscopy revealed significant differences in the fenestration frequency (F = 37.730, P < 0.001) and porosity (F = 16.010, P < 0.001) on the surface of mouse LSECs among the four groups, and reduced fenestration frequency and porosity were observed in the 1-[(1.22 ± 0.48)/μm2 and [(3.05 ± 0.91)%] and 2-week infection groups [(3.47 ± 0.10)/μm2 and (7.57 ± 0.23)%] groups than in the control group (all P values < 0.001). There was a significant difference in the average fenestration diameter on the surface of mouse LSECs among the four groups (F = 15.330, P < 0.001), and larger average fenestration diameters were measured in the 1-[(180.80 ± 16.42) nm] and 2-week infection groups [(161.70 ± 3.85) nm] than in the control group (both P values < 0.05). In addition, there were significant differences among the four groups in terms of Stabilin-1 (F = 153.100, P < 0.001), Stabilin-2 (F = 57.010, P < 0.001), Ehd3 (F = 31.700, P < 0.001), CD209b (F = 177.400, P < 0.001), GATA4 (F = 17.740, P < 0.001), and Maf mRNA expression (F = 72.710, P < 0.001), and reduced mRNA expression of Stabilin-1, Stabilin-2, Ehd3, CD209b, GATA4 and Maf genes was quantified in three infection groups than in the control group (all P values < 0.001).

CONCLUSIONS

E. multilocularis infections may induce capillarization of LSECs in mice, and result in a reduction in the expression of functional and phenotypic marker genes of LSECs, and capillarization of LSECs occurs earlier than activation of HSC and development of hepatic fibrosis.

Association of the combination of obstructive sleep apnea risk and sleep duration with ideal cardiovascular health metrics in patients undergoing hemodialysis

BACKGROUND

The purpose of this study was to explore the separate and combined associations of obstructive sleep apnea (OSA) risk and sleep duration with ideal cardiovascular health metrics in hemodialysis (HD) patients.

METHODS

470 HD participants (average: 59.48 ± 12.89 y, 281 men) were included in this study. Sleep duration was measured as self-reported average sleep time during the previous month. The OSA risk was assessed using the STOP-BANG questionnaire. Participants were divided into three groups based on the number of ideal cardiovascular health (CVH) metrics: 0-2,3-4, and 5-7. Ordinal logistic regression was conducted to model the associations of CVH metrics with sleep duration, OSA risk, and their combined effects by adjusting for specific covariates.

RESULTS

After adjusting for covariates, short sleep duration (< 7 h) (OR = 0.53; 95% CI [ 0.30, 0.92]) and OSA risk (OR = 0.58; 95% CI [0.32, 0.83]) were negatively associated with better CVH (ideal vs. intermediate; intermediate vs. poor), respectively. For HD patients with both short sleep duration and OSA risk, the odds of ideal CVH metrics were reduced by 72% (odds ratio 0.28 [95% CI 0.13, 0.60]).

CONCLUSIONS

Short sleep duration and OSA risk are separately and jointly associated with poor CVH in hemodialysis patients. Suitable interventions for sleep may minimize the risk of developing cardiovascular disease.

Association between changes in depressive symptoms and falls: The China health and retirement longitudinal study (CHARLS)

PURPOSE

This study aimed to investigate the impact of depressive symptoms and changes in depressive status on falls among middle-aged and older population in China.

METHODS

We used two waves of interview data (time 1 [T1] and time 2 [T2], 2 years from T1) from a nationally representative sample of the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 14,356 participants (male 6859; mean age: 59.5 ± 9.3 years). Depressive symptoms were assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Participants were categorized into four groups based on changes in their CES-D-10 scores over a 2-year follow-up period. Self-reported falls were evaluated, and logistic regression models and restricted cubic splines (RCS) were employed to examine the relationship between depressive symptoms and fallen.

RESULTS

Participants who had experienced falls had higher CES-D-10 scores and were more likely to have depressive symptoms. Depressive symptoms at T1 were significantly associated with falls during the follow-up period. After adjusting for covariables, increasing CES-D-10 scores were associated with higher adjusted odds ratios (ORs) for falling prevalence: 1.230 (95 % CI, 1.041-1.453), 1.579 (95 % CI, 1.331-1.873), 1.745 (95 % CI, 1.472-2.070), and 2.366 (95 % CI, 1.972-2.838). Participants who experienced depressive symptoms at either T1 or T2, as well as those with persistent depressive symptoms from T1 to T2, were both at higher risk for future falls. The worsening of depressive symptoms significantly increased the likelihood of falls.

CONCLUSION

This study revealed a significant association between depressive symptoms and changes in depressive status with subsequent falls in older adults. The heightened fall risk among individuals with depressive symptoms underscores the importance of addressing mental health as an integral part of comprehensive fall prevention strategies.

[Preliminary survey report on the clinical validation of in-use electronic sphygmomanometers in China]

Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.

Mediating effect of gait speed on the relationship between ankle-brachial index and mild cognitive impairment in hemodialysis patients

BACKGROUND

Patients undergoing hemodialysis are highly predisposed to arterial disease, poor physical performance, and cognitive impairment. However, the connection between them is not yet known. We aimed to investigate the mediating effect of physical performance on the relationship between arterial stiffness and mild cognitive impairment (MCI).

METHODS

We conducted a multicenter cross-sectional study. The final analyzed hemodialysis patients comprised 616 subjects (men 391, women 225) from seven dialysis units in Shanghai, China. MCI was assessed by Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale. Arterial function was measured by ankle-brachial index (ABI) and branchial-ankle pulse-wave velocity (baPWV). Physical function was assessed by the Short Physical Performance Battery (SPPB). Logistic regression and mediation model were used to analysis.

RESULTS

The mean age of the final analysis sample (n = 616) was 59.0 ± 12.0 years. Hemodialysis patients with MCI were more likely to have lower ABI (p < 0.001) and higher baPWV (p < 0.01). After adjusting for covariates, lower ABI (abnormal ≤0.9 and borderline 0.91-0.99) were positively associated with MCI (OR = 4.43, 95% CI = 1.89-10.39; OR = 4.83, 95% CI = 1.61-14.46). SPPB total score and its components standing balance, gait speed score were negatively associated with MCI. In the mediational model, gait speed played a mediating role (indirect effect ab = -0.21; 95% CI = -0.58 to -0.03) in the association of ABI (≤0.9) and MMSE, while standing balance and chair stands did not.

CONCLUSIONS

Lower gait speed mediates a positive association between ABI and MCI in hemodialysis patients. Suitable interventions for physical performance, especially gait speed, may reduce the risk of MCI in hemodialysis patients.

A prognostic model based on ferroptosis-related long non-coding RNA signatures and immunotherapy responses for non-small cell lung cancer

OBJECTIVE

Non-small cell lung cancer (NSCLC) ranks high in the incidence of malignant tumors, with limited treatment options and poor prognosis. Ferroptosis is a newly discovered cell death mechanism based on iron and reactive oxygen species (ROS). The role of ferroptosis-related long non-coding RNAs (lncRNAs) and associated prognostic mechanisms in NSCLC require investigation.

MATERIALS AND METHODS

We constructed a prognostic multi-lncRNA signature based on ferroptosis-related differentially expressed lncRNAs in NSCLC. The levels of ferroptosis-related lncRNA in normal lung cells and lung adenocarcinoma cells were verified by RT-PCR.

RESULTS

We identified eight differentially expressed lncRNAs associated with NSCLC prognosis. The expression of AC125807.2, AL365181.3, AL606489.1, LINC02320, and AC099850.3 was upregulated, while SALRNA1, AC026355.1, and AP002360.1 were downregulated in NSCLC cell lines. Kaplan-Meier analysis showed that a high-risk patient group was associated with poor NSCLC prognosis. A risk assessment model based on ferroptosis-related lncRNAs was superior to NSCLC prognosis based on traditional clinicopathological features. Gene Set Enrichment Analysis (GSEA) identified immune- and tumor-related pathways in low-risk group patients. In addition, The Cancer Genome Atlas (TCGA) showed that T cell function during APC co-inhibition, APC co-stimulation, chemokine receptor (CCR), MHC class I, parainflammation, T cell co-inhibition, and check-point expression differed significantly between low- and high-risk groups. M6A-related mRNA comparisons between these groups also revealed significant differences in ZC3H13, RBM15, and METTL3 expression.

CONCLUSIONS

Our new model of lncRNA-associated ferroptosis effectively predicted NSCLC prognoses.

Observation of the effectiveness of clinical indicators of cardiac shock wave therapy in patients with ischemic heart disease: A systematic review and meta-analysis

Objective

Ischemic heart disease (IHD) has a high prevalence and mortality rate, imposing a heavy burden on patients and society, and there is still a need to optimize treatment options for IHD patients. Cardiac shock wave therapy (CSWT) is gaining popularity as a new treatment for IHD patients. The objective of this meta-analysis is to reassess the effects of CSWT on IHD patients in light of the limited number of clinical studies included in previously published reviews, inconsistent methodological quality, and unclear outcomes.

Methods

From database creation until September 1, 2022, 4 English databases and 3 Chinese databases were rigorously searched for any current controlled trials of CSWT for IHD. The Cochrane Risk of Bias Assessment Tool was used for methodological quality assessment. Review Manager v.5.4 software was used for meta-analysis.

Results

Nineteen published controlled trials totaling 1,254 subjects were included. Results showed that CSWT could enhance left ventricular function and myocardial viability, improve cardiac function and alleviate angina pectoris symptoms. The effects of CSWT and control groups on SAQ scores and exercise time were not statistically significant.

Conclusion

According to this systematic review and meta-analysis, CSWT may be beneficial for a number of IHD clinical indications. To verify these findings, more RCT studies with bigger sample numbers and higher methodological standards are required in the future.

[Immunoprotective effect of recombinant peptidyl-prolyl cis-trans isomerase from Babesia microti against B. microti infection in mice]

OBJECTIVE

To evaluate the immunoprotective effect of active immunization with recombinant peptidyl-prolyl cis-trans isomerase from Babesia microti against B. microti infection in mice.

METHODS

Female BALB/c mice at 6 weeks of age, each weighing approximately 20 g, were divided into the recombinant protein immunization group, the infection control group and the normal control group, of 25, 18, 15 mice in each group, respectively. Mice in the recombinant protein immunization group were given active immunization with recombinant BmPPIase protein, and 18 mice with the highest antibody titers were intraperitoneally injected with 100 μL of B. microti-infected whole blood 2 weeks after the last immunization. Mice in the infection control group were intraperitoneally injected with 100 μL of B. microti-infected whole blood, while 15 mice in the normal control group received no treatment. Blood samples were collected from mice in the recombinant protein immunization group and the infection control group on days 0 to 30 post-immunization for detection of B. microti infection, and blood samples were collected on days 0, 7, 14, 21, and 28 post-immunization for routine blood tests with a blood cell analyzer and for detection of serum cytokines using cytometric bead array.

RESULTS

Anti-BmPPIase antibodies were detected in 25 mice in the recombinant protein immunization group 2 weeks after the last immunization, with titers of 5 × 10³ to 8 × 10⁴. B. microti infection rate peaked in mice in both the recombinant protein immunization and the infection control group on day 7 post-immunization, with positive infection rates of 13.3% and 50.0%, and there were significant differences between the two groups in terms of B. microti infection rate on days 3 (χ²= 113.18, P < 0.01), 5 (χ² = 475.22, P < 0.01), 7 (χ² = 465.98, P < 0.01) and 9 post-infection (χ²= 18.71, P < 0.01), while the B. microti infection rate tended to be 0 in both groups on day 11 post-immunization. Routine blood tests showed higher red blood cell counts [(5.30 ± 0.50) × 10¹² to (9.87 ± 0.24) × 10¹² counts/L)] and hemoglobin levels [(89.67 ± 22.80) to (148.60 ± 3.05) g/L)] in the recombinant protein immunization group than in the infection control group on days 0 to 28 post-immunization. Cytometric bead array detected higher serum interferon-γ [(748.59 ± 17.56) to (3 858.28 ± 1 049.10) fg/mL], tumor necrosis factor-α [(6 687.34 ± 1 016.64) to (12 708.13 ± 1 629.79) fg/mL], interleukin (IL)-6 [(611.05 ± 75.60) to (6 852.68 ± 1 554.00) fg/mL] and IL-17a [(167.68 ± 185.00) to (10 849.27 ± 355.40) fg/mL] and lower IL-10 levels [(247.65 ± 138.00) to (18 787.20 ± 2 830.22) fg/mL] in the recombinant protein immunization group than in the infection control group during the study period.

CONCLUSIONS

Recombinant BmPPIase protein induces up-regulation of interferon-γ, tumor necrosis factor-α and presents a high immunoprotective activity against B. microti infection in mice, which is a potential vaccine candidate protein.

[Mechanism of hepatic fibrosis associated with Echinococcus: a review]

Echinococcosis is a zoonotic parasitic disease caused by Echinococcus infections, and this disorder may cause fibrosis of multiple vital organs, which may further progress into cirrhosis. Early-stage hepatic fibrosis is reversible, and unraveling the mechanisms underlying hepatic fibrosis induced by Echinococcus infections is of great significance for the prevention and treatment of early-stage hepatic fibrosis. Recently, the studies pertaining to hepatic fibrosis associated with Echinococcus infections focus on cytokines and immune cells. This review summarizes the advances in the mechanisms underlying host immune cells- and cytokines-mediated hepatic fibrosis in humans or mice following Echinococcus infections.

Comparison of three nutritional screening tools for detecting sarcopenia in patients with maintenance hemodialysis

Background

Malnutrition, dynapenia, and sarcopenia are prevalent conditions among patients with maintenance hemodialysis (MHD). They are related to numerous adverse health outcomes. The aim of this study was to compare the effect of three nutritional screening tools on predicting the risk of dynapenia and sarcopenia in patients with MHD.

Methods

From July 2020 to April 2021, a total of 849 patients with MHD were enrolled at seven different healthcare facilities in Shanghai, China in this multi-center cross-sectional study. Geriatric nutritional risk index (GNRI), malnutrition inflammation score (MIS), and creatinine (Cr) index were used for nutritional assessment. The cutoff values of muscle mass and strength to define dynapenia, pre-sarcopenia, and sarcopenia were based on the consensus by the Asia Working Group of Sarcopenia in 2019.

Results

Among 849, almost 60% were malnourished with the majority suffering from dynapenia (27.7%), followed by sarcopenia (22.7%), and pre-sarcopenia (6.2%).The area under the receiver-operating characteristic curve for GNRI was 0.722 [95% confidence interval (CI) = 0.684-0.760] and 0.723 (95% CI = 0.663-0.783) in predicting sarcopenia and pre-sarcopenia. The GNRI [odds ratio (OR) =6.28, 95% CI: 4.05-9.73], MIS (OR =1.91, 95% CI: 1.31-2.78), and the Cr index (OR =2.73, 95% CI: 1.71-4.34) were all significantly associated with the risk of sarcopenia. More importantly, the sarcopenia predictability of the GNRI appears greater than the MIS and Cr index, while MIS was similar to the Cr index. Similarly, the superiority of GNRI prediction was also found in pre-sarcopenia, but not in dynapenia.

Conclusion

All the three nutritional screening tools were significantly associated with an increased risk of sarcopenia. The sarcopenia predictability of the GNRI was greater than the MIS and Cr index.

Different stages of chronic kidney disease are associated with physical performance in adults over 60 years

Objective

The purpose of this study was to determine the association between different stages of chronic kidney disease (CKD) and sarcopenia and its components in the Chinese older population.

Methods

The study comprised of 2,213 participants aged ≥ 60 years (1,025 men; mean age: 70.7 years) recruited from Shanghai who were invited to participate in a comprehensive geriatric assessment. Sarcopenia was defined according to the AWGS 2019 consensus update on sarcopenia diagnosis criteria. The glomerular filtration rate (GFR) was estimated using the equation that originated from the CKD-EPI equation, the stages of CKD are classified according to the Kidney Disease-Improving Global Outcomes (KDIGO).

Results

The overall prevalence of sarcopenia was 19.0%, which increased with the severity of CKD. The prevalence of sarcopenia in patients with CKD 3-4 and kidney failure was significantly higher than that in normal and CKD 1-2 (p < 0.05). In logistic regression analysis model, compared with normal and CKD 1 patients, kidney failure was significantly associated with the increased risk of sarcopenia and low grip strength (p < 0.05); CKD 2, CKD 3-4 and kidney failure groups were significantly associated with an increased risk of low walking speed (p < 0.05), respectively; while the association between CKD and muscle mass was not shown.

Conclusions

In our study, only decreased physical performance, as represented by walking speed, was significantly associated with increased CKD severity. This may improve the evidence for the prevention and intervention of sarcopenia in patients with CKD.

Advances in the study of molecular identification technology of Echinococcus species

The larvae of Echinococcus (hydatidcyst) can parasitize humans and animals, causing a serious zoonotic disease-echinococcosis. The life history of Echinococcus is complicated, and as the disease progresses slowly after infection, early diagnosis is difficult to establish. Due to the limitations of imaging and immunological diagnosis in this respect, domestic and foreign scholars have established a variety of molecular detection techniques for the pathogen Echinococcus over recent years, mainly including nested polymerase chain reaction (PCR), multiplex PCR, real-time quantitative PCR, and nucleic acid isothermal amplification technology. In this article, the research progress of molecular detection technology for Echinococcus infection currently was reviewed and the significance of these methods in the detection and diagnosis of hydatid and hydatid diseases was also discussed.

Alteration of plasma metabolic profile and physical performance combined with metabolites is more sensitive to early screening for mild cognitive impairment

Objective

Unbiased metabolic profiling has been initiated to identify novel metabolites. However, it remains a challenge to define reliable biomarkers for rapid and accurate diagnosis of mild cognitive impairment (MCI). Our study aimed to evaluate the association of serum metabolites with MCI, attempting to find new biomarkers and combination models that are distinct for MCI.

Methods

A total of 380 participants were recruited (mean age: 72.5 ± 5.19 years). We performed an untargeted metabolomics analysis on older adults who underwent the Mini-Mental State Examination (MMSE), the Instrumental Activities of Daily Living (IADL), and physical performance tests such as hand grip, Timed Up and Go Test (TUGT), and walking speed. Orthogonal partial least squares discriminant analysis (OPLS-DA) and heat map were utilized to distinguish the metabolites that differ between groups.

Results

Among all the subjects, 47 subjects were diagnosed with MCI, and methods based on the propensity score are used to match the MCI group with the normal control (NC) group (n = 47). The final analytic sample comprised 94 participants (mean age: 75.2 years). The data process from the metabolic profiles identified 1,008 metabolites. A cluster and pathway enrichment analysis showed that sphingolipid metabolism is involved in the development of MCI. Combination of metabolite panel and physical performance were significantly increased discriminating abilities on MCI than a single physical performance test [model 1: the area under the curve (AUC) = 0.863; model 2: AUC = 0.886; and model 3: AUC = 0.870, P < 0.001].

Conclusion

In our study, untargeted metabolomics was used to detect the disturbance of metabolism that occurs in MCI. Physical performance tests combined with phosphatidylcholines (PCs) showed good utility in discriminating between NC and MCI, which is meaningful for the early diagnosis of MCI.

Feasibility of an ultra-low dose contrast media protocol for coronary CT angiography

AIM

To evaluate the feasibility of an ultra-low volume contrast media (CM) protocol for coronary computed tomography angiography (CTA).

MATERIALS AND METHODS

In total, 214 patients receiving coronary CTA were enrolled prospectively and divided into group A (n=107) receiving a conventional dose of CM and group B (n=107) receiving an ultra-low dose. CT values of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) were measured and radiation doses recorded. The image quality was compared between the groups. Changes in renal function indices and proteinuria before, 24, and 72 hours after coronary CTA among those with chronic kidney disease (CKD) were also assessed.

RESULTS

There were significant differences in CT values and radiation doses between groups A and B. In group A, the average RCA, LAD, and LCX CT values were 412.5 ± 79.2, 423.5 ± 73.7, and 422.0 ± 88.1 HU, respectively. In group B, the average RCA, LAD, and LCX CT values were 275.2 ± 16.2, 277.8 ± 16.4, and 278.9 ± 16.5 HU, respectively. The radiation dose in the ultra-low protocol recipients (118.70 ± 18.52 mGy·cm) was significantly lower than that used in conventional coronary CTA (131.75 ± 20.96 mGy·cm). The image quality of group B was comparable to that of group A, satisfying the diagnostic requirement. In patients with mild CKD, there were no significant differences in renal functions after coronary CTA.

CONCLUSION

An ultra-low CM protocol was established for coronary CTA, providing comparable image quality and diagnostic yields but significantly lower radiation dose compared with a conventional protocol. This new protocol might be applicable to patients with mild CKD.

Relationship between physical performance and mild cognitive impairment in elderly hemodialysis patients is modified by the presence of diabetes: A multicenter cross-sectional study

OBJECTIVE

The purpose of this study was to observe the relationship between physical performance and mild cognitive impairment (MCI) in the presence or absence of type 2 diabetes in elderly hemodialysis patients.

METHODS

In this multicenter cross-sectional study, 396 clinically stable and aged ≥60 years hemodialysis patients (255 men; mean age: 68.3 ± 5.9 years) were included from seven dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were utilized to assess MCI. The performance-based assessments consisted of three physical tests, grip strength (GS), Timed Up and Go Test (TUGT), and 4-m walking test, which respectively represent muscle strength, mobility, and walking speed (WS). Logistic regression and multivariate linear regression were used for analysis.

RESULTS

Hemodialysis patients with diabetes had a high prevalence of MCI (20.6%). The odds ratio (OR) of MCI for the interacted items [(TUGT) * (diabetes) and (WS) * (diabetes)] was significant (p < 0.05). In diabetes patients, TUGT was positively associated with MCI, and WS was negatively associated with MCI after adjusting covariates [OR = 0.129; 95% confidence interval (CI) = 0.028-0.704, p = 0.021]. However, no significant association was found between physical performance and MCI in the non-diabetes hemodialysis patients (p > 0.05). Further analysis showed that TUGT was negatively associated with attention and calculation and language. WS was positively associated with recall and language in diabetic hemodialysis patients.

CONCLUSIONS

Physical performance was associated with MCI in diabetic hemodialysis patients rather than the non-diabetes group. Whether increasing mobility or WS can positively influence MCI in individuals with type 2 diabetes requires further study.

Association between Sleep Duration and Mild Cognitive Impairment at Different Levels of Metabolic Disease in Community-Dwelling Older Chinese Adults

OBJECTIVES

The purpose of this study was to investigate the relationship between metabolic syndrome (MetS), sleep duration and mild cognitive impairment (MCI) in community-dwelling older Chinese adults.

METHODS

The study comprised of 1367 community-dwelling Chinese participants (563 men; mean age: 71.0 years) recruited from Tianjin and Shanghai, China who were invited to participate in a comprehensive geriatric assessment. The International Diabetes Federation metabolic syndrome guidelines were used to define MetS. The Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were used for the initial classification of patients with MCI. We divided sleep duration into five groups (≤6 h, 6-8 h which was used as the reference, 8-9 h, 9-10 h, and >10 h). Nutritional status was assessed by Mini Nutrition Assessment Short Form.

RESULTS

The overall incidence of metabolic syndrome was 46.7%, the overall incidence of mild cognitive impairment was 17.4%. In logistic regression analysis model, after adjusting for multiple confounding factors such as nutritional status and physical activity level, there was a significant positive association between long sleep duration (> 10h) and mild cognitive impairment in general population and metabolic syndrome population (p<0.05), but the association was not significant in non-metabolic syndrome group. In addition, in the long sleep duration group, the components of metabolic syndrome, elevated blood glucose were significantly associated with mild cognitive impairment (p<0.05).

CONCLUSIONS

Long sleep duration was significantly associated with increased risk of MCI in older adults with MetS, but not in those without MetS. The prevention of MCI may be more effective in the population of MetS with long sleep duration.

Mediating Effects of Malnutrition on the Relationship between Depressive Symptoms Clusters and Muscle Function Rather than Muscle Mass in Older Hemodialysis Patients

OBJECTIVES

The purpose of this study was to investigate the association and mediation pathways among muscle mass, muscle function (muscle strength and physical performance), and malnutrition with depressive symptoms clusters in the older hemodialysis patients.

DESIGN

A multi-center cross-sectional study.

SETTING AND PARTICIPANTS

A total of 499 patients aged ≥ 60 on hemodialysis from seven facilities in Shanghai of China from 2020 to 2021.

MEASUREMENTS

Muscle mass was assessed by skeletal muscle index(SMI). Muscle strength was measured by handgrip strength, and physical performance was measured via gait speed and Timed Up and Go Test (TUGT). Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Logistic regression and mediation analyses fully adjusted for all potential confounding factors.

RESULTS

Among 499 participants (312 men, mean age 69.2±6.6 years), 108 (21.6%) had depressive symptoms. The muscle strength, physical performance and malnutrition were associated with depressive symptoms. Furthermore, malnutrition significantly mediated the association of muscle function with total, cognitive-affective symptoms. The association of the muscle function with somatic symptoms were mediated by the nutritional status. The mediated proportions of malnutrition in the relationship between physical performance and depressive symptoms clusters were stronger in somatic symptoms than in cognitive-affective symptoms.

CONCLUSIONS

Our findings suggest that muscle function rather than muscle mass may contribute substantially to the development of depressive symptoms clusters in the hemodialysis via malnutrition. The malnutrition mediated stronger in the association of muscle function with somatic symptoms. These findings may help guide clinicians to better diagnose and manage depression in the context of concomitant muscle function and malnutrition.

Comparison of Inflammatory Markers in the Diagnosis of Metabolic Syndrome in Hemodialysis Patients: A Multicenter Observational Study

OBJECTIVE

The purpose of this study is to observe the correlation between high sensitivity C-reactive protein (hs-CRP) and metabolic syndrome (MetS) in hemodialysis patients, determine its optimal cut-off point value, and compare the diagnostic ability of different inflammatory markers for MetS.

METHODS

This cross-sectional study finally included 860 long-term hemodialysis patients (male 524, average age 61.5 years) from seven dialysis centers in Shanghai, China. The International Diabetes Federation metabolic syndrome guidelines were used to define MetS, including high waist circumference, elevated blood pressure, elevated fasting blood glucose, elevated triglycerides, and reduced HDL cholesterol. Serum hs-CRP was determined by the immunonephelometric assay. The association with MetS was observed according to the quartile of inflammatory markers, and then the optimal cut-off point value of the hs-CRP was determined by ROC analysis.

RESULTS

The overall prevalence of MetS was 55.1% (46.6% in males and 68.5% in females). In the final logistic regression model, there was a significant, graded positive association between hs-CRP and MetS (p for trend = 0.010). The traditional inflammatory markers leukocytes, neutrophils, lymphocytes, monocytes and neutrophil-to-lymphocyte ratio (NLR) were not associated with MetS. The results of the ROC analysis showed that the optimal cut point value of hs-CRP for the diagnosis of MetS was 1.58 mg/L. In the components of MetS and hs-CRP was significantly positively associated with high waist circumference, elevated TG and low HDL (p < 0.05).

CONCLUSION

The increase in hs-CRP concentration is significantly associated with the risk of MetS, and the diagnostic ability of hs-CRP for MetS is better than traditional inflammatory markers.

Sarcopenia and coronary heart disease synergistically increase the risk of new onset depressive symptoms in older adults

Background

Coronary heart disease (CHD), sarcopenia and depression are common disorders that markedly impair quality of life and impose a huge financial burden on society. They are also frequently comorbid, exacerbating condition and worsening prognosis. This study aimed to investigate the additive effects of CHD and sarcopenia on the risk of new onset depressive symptoms in older adults.

Methods

The prospective cohort study comprised 897 Chinese community-dwelling participants who were aged 60 years and older (386 men; mean age 66.9 ± 5.9 years) without depressive symptoms at baseline, recruited from Chadian of Tianjin, China. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. CHD was identified via medical records or new diagnosed by at least two physicians. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS) ≥11. Longitudinal data on new onset depressive symptoms were collected up to 12 months after baseline.

Results

We found that 103 (11.5%) of the 897 participants without depressive symptoms at baseline had developed depressive symptoms. Participants were classified into mutually exclusive groups based on sarcopenia status and CHD: normal, CHD alone, sarcopenia alone, and co-occurring groups. A logistic regression showed that the CHD alone [odd ratios (OR) = 1.78, 95% confidence interval (CI) = 1.05–3.02], sarcopenia alone (OR = 2.79, 95% CI = 1.26–6.22), and co-occurring (OR = 7.19, 95% CI = 2.75–18.81) had higher risk of depressive symptoms than the normal group after adjusting for the covariates.

Conclusions

CHD and sarcopenia synergistically increase the risk of new onset depressive symptoms in older adults. Thus, older adults may require early detection, and appropriate interventions should be implemented.

The Added Value of Combined Timed Up and Go Test, Walking Speed, and Grip Strength on Predicting Recurrent Falls in Chinese Community-dwelling Elderly

Purpose

To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any-falls or recurrent-falls.

Participants and Methods

This prospective cohort study included a total of 875 elderly participants (mean age: 67.10±5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments.

Methods

We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests—timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment.

Results

In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as “+” while poor performance as “–”. After multivariate adjustment, we found “TUGT >10.31 s” showed a strong correlation with both any-falls (adjusted odds ratio (OR)=2.025; 95% confidence interval (CI)=1.425–2.877) and recurrent-falls (adjusted OR=2.150; 95%CI=1.169–3.954). Among combined functional models, “TUGT >10.31 s, GS <0.3742 kg/kg, WS >0.9467 m/s” showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982–10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880–17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782–0.884, P<0.001), while not better than a single test in predicting any-fallers (P=0.083).

Conclusion

Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined “TUGT–, GS–, WS+” model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.

Advances in research on the relationship between the gut microbiome and cancer

OBJECTIVE

The objective of this review is to provide currently available information on the relationship between the gut microbiome and cancer.

MATERIALS AND METHODS

In this mini-review, we explored the PubMed, EMBASE, and Google Scholar electronic databases, with regards to the searching terms "gut microbiome, cancer, intestinal flora, immunotherapy, immune checkpoint inhibitor". By reviewing and analyzing the literature, we analyzed how the bacterial microbiome influences the immune system and cancer, as well as how changes in symbiotic flora may be applied to improve the efficacy of cancer immunotherapy.

RESULTS

The microbiota is related to the development of tumors and may promote canceration. In recent years, a number of studies have confirmed the influence of intestinal flora on immune checkpoint inhibitors in cancer patients, and studies have also shown the link between the intestinal microbiome and treatment-related immune toxicity. Antibiotics, proton pump inhibitors, and hormones affect the composition of the gut microbiota.

CONCLUSIONS

Intestinal flora is closely related to cancer. Intestinal flora has a certain impact on cancer occurrence, cancer treatment, cancer immunotherapy efficacy, and side effects.

[Construction of a cDNA library for Sparganum mansoni and screening of diagnostic antigen cadidates]

OBJECTIVE

To construct a cDNA library of Sparganum mansoni and immunoscreen antigen candidates for immunodiagnosis of sparganosis mansoni.

METHODS

Total RNA was extracted from S. mansoni, and reversely transcribed into cDNA, which was ligated into the phage vector. These recombinant vectors were packaged in vitro to construct the SMART cDNA library of S. mansoni. Then, the cDNA library was immunoscreened with sera from patients with sparganosis mansoni to yield positive clones. The inserted fragments of positive clones were sequenced and subjected to homology analyses, and the structure and functions of the coding proteins were predicted.

RESULTS

The SMATR cDNA library of S. mansoni was successfully constructed. The titer of the cDNA library was 6.25 × 10⁶ pfu/mL, with a recombinant efficiency of 100%, and the mean length of the inserted fragments in the library was larger than 1 100 bp. A total of 12 positive clones were obtained by immunoscreening, and were categorized into Sm-I (Sm60-1), Sm-II (Sm58-1), Sm-III (Sm20-1) and Sm-IV (Sm22-3), with 1 134, 1 063, 883 bp and 969 bp long inserted fragments. Their coding proteins were highly homologous with the Spirometra erinaceieuropaei antigenic polypeptide, cytoplasmic antigen, ribosomal protein S4-like protein and unnamed protein product, respectively.

CONCLUSIONS

A SMART cDNA library of S. mansoni has been successfully constructed and 4 categories of positive clones have been identified, which provides a basis for further studies on diagnostic antigens for sparganosis mansoni.

[The possibility of neoadjuvant chemotherapy course adjustment for delayed operation of patients with esophageal cancer in special period]

Objective: To investigate the effect of the neoadjuvant chemotherapy course adjustment on the patients with esophageal cancer underwent delayed operation. Methods: The clinical data of patients with esophageal cancer treated in Cancer Hospital, Chinese Academy of Medical Sciences from 2019-2020, who underwent neoadjuvant chemotherapy strategy adjustment (multiple course chemotherapy group) or not (control group), were retrospectively studied. The clinical pathological characteristics and postoperative complication of these two group were compared and analyzed. Results: The cases who underwent the interval between chemotherapy and operation more than 4 weeks in multiple course chemotherapy group and control group were 17 and 6, with significant difference (P<0.05). The average operative blood loss of these two groups were 88.6 ml and 46.1 ml, the average postoperative hospital stays were 14.7 days and 10.0 days, with significant difference (P<0.05). The incidence rate of postoperative complication in the multiple course chemotherapy group was 40.9% (9/22), not significantly different from 31.8% (7/22) of control group (P>0.05). There were no death within postoperative 7 days and 30 days in both groups. Cases with apparent tumor regression [tumor regression grade (TRG) 1 to 3] in multiple course chemotherapy group were 14, with marginal tumor regression (TRG 4 to 5) were 8, while there were 7 and 15 in the control group, respectively, with significant difference (P<0.05). After multiple neoadjuvant chemotherapy, the imaging examination of patients indicated an almost total tumor degradation and the postoperative pathology showed no residual malignant tumor tissue was observed. Conclusions: Increased neoadjuvant chemotherapy course for patients with locally advanced esophageal cancer can obtain more obvious tumor degradation response. Neoadjuvant chemotherapy adjustment according to the operation schedule is recommended.

[Progress in diagnosis and treatment of lung adenocarcinomas imaging manifesting as radiological part-solid nodule]

The incidence and mortality of lung cancer ranked the first in China. China had 787, 000 new cases of lung cancer in 2015, and a majority of these patients with advanced lung cancer. With the development and popularization of high-resolution computed tomography, more and more early-stage lung adenocarcinomas are found in screening. The imaging finding of early-stage lung adenocarcinomas often manifests as part solid nodule (PSN) containing ground glass opacity (GGO). Although the imaging manifestation of the nodules can't accurately predict the pathologic type of nodules, the parts of solid nodule and GGO still have some pathologic indications, and the prognostic evaluation effect of the maximum diameter of PSN is superior to that of the whole nodule. With the development of the molecular radiography and molecular pathology, the relationship of imaging manifestation of the PSN and metastasis were focused on. Some PSNs with special nature are more active and rapidly progressed than the pure GGOs. While compared to the pure solid nodules, the aggressiveness of PSNs are insufficient, with lower metastatic rates of lymph node and better prognoses. Currently, international acknowledge recommends to take active intervention measure for PSNs which are highly suspected to be malignant. We focus on the diagnosis and treatment of PSNs, systemically depict their staging, follow-up, surgical treatment, gene detection and immunotherapy.

Association Between Physical Performance and Cognitive Function in Chinese Community-Dwelling Older Adults: Serial Mediation of Malnutrition and Depression

Purpose

We aimed to propose a serial mediational model to further analyze the relationship between poor physical performance, malnutrition, depression and cognitive impairment in Chinese community-dwelling older adults.

Patients and Methods

This study consisted of 1386 community-dwelling Chinese older adults aged 65 years and older in Shanghai, China. Mild cognitive impairment (MCI) was assessed by the Mini-Mental State Examination (MMSE) and Instrumental Activities Of Daily Living (IADL). Physical performance was assessed by short physical performance battery (SPPB). Malnutrition was defined with the Mini Nutritional Assessment (MNA). Depressive symptoms were evaluated by the 30-item Geriatric Depression Scale (GDS). Serial multiple mediator models were used.

Results

The mean age of the final analysis sample was 73.62±6.14, and 57.6% (n=809) were females. The prevalence of MCI was 14.35% (n=199). Physical performance (p<0.001), nutritional status (p=0.025), and depressive symptoms (p=0.002) were correlated with MCI. The serial mediational model revealed that MNA and GDS scores significantly mediated association of SPPB and MMSE scores (c'=0.4728, p<0.001). Furthermore, depressive symptoms significantly mediated the association of physical performance and cognition (p=0.0311), while malnutrition had no independent mediating effect between these two factors (p=0.794).

Conclusion

Our study examined the serial multiple mediation roles of nutritional status and depressive symptoms on the relationship between physical performance and cognitive function in community-dwelling Chinese older adults. Older adults who were in poor physical condition tend to have worse nutritional status, more severe depression, and poorer cognitive function.

Mediating effects of lower extremity function on the relationship between night sleep duration and cardiovascular disease risk: a cross-sectional study in elderly Chinese without cardiovascular diseases

OBJECTIVE

The purpose of this study is to investigate the mediating effect of physical performance on the relationship between night sleep duration and risk of cardiovascular disease (CVD) in elderly Chinese without CVD.

METHODS

782 participants without CVD over 65 years (average: 70.82±3.86 years, 448 women) were included in this study. CVD risk was calculated by the Framingham Risk Score and participants were divided into four groups of night sleep duration (in hours): <7 hours, ≥7-8 hours, >8-9 hours and >9 hours. Upper extremity function was measured by grip strength and lower extremity function was measured by the Short Physical Performance Battery (SPPB), consisting of balance, 4 m walk and chair stands tests.

RESULTS

After adjusting for covariates, long night sleep duration (>9 hours) and CVD risk were significantly positively associated compared with moderate night sleep duration (≥7-8 hours) (β=1.152; 95% CI 0.05 to 2.25). SPPB total score (indirect effect ab=-0.122; 95% CI -0.291 to -0.0008) rather than grip strength partially mediated the relationship between long night sleep duration and CVD risk, in which chair stands played a major mediating role (indirect effect ab=-0.171; 95% CI -0.040 to -0.0006), while balance (indirect effect ab=-0.016; 95% CI -0.100 to 0.063) and 4 m walk (indirect effect ab=0.048; 95% CI -0.066 to 0.201) did not.

CONCLUSIONS

Lower extremity function, especially lower limb muscle strength, partially mediates a positive association between long night sleep duration and CVD risk in the elderly without CVD. Suitable interventions for physical performance and sleep may minimise the risk of subsequent CVD.

Relationships between sarcopenia, depressive symptoms, and mild cognitive impairment in Chinese community-dwelling older adults

BACKGROUND

Mild cognitive impairment (MCI) represents an intermediate state between normal cognitive aging and dementia. We aimed to investigate the association and mediation pathways of sarcopenia, including its individual components (muscle mass, muscle strength, and physical performance), and depressive symptoms with MCI in the older adults.

METHODS

This study consisting of 1394 community-dwelling Chinese older adults aged 60 years and older in Tianjin and Shanghai, China. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. Depressive symptoms were evaluated by the 30-item Geriatric Depression Scale (GDS). Cognitive function was assessed by Mini-Mental State Examination (MMSE), the Chinese version of the Dementia Rating Scale (CDRS) was used to apply the diagnostic of non-dementia, and instrument activities of daily living (IADL) were used to evaluate daily living activities. Logistic regression and mediation analyses fully adjusted for all potential confounding factors were conducted.

RESULTS

Sarcopenia, handgrip strength, gait speed, and depressive symptoms were associated with MCI. Furthermore, depressive symptoms significantly mediated the association of sarcopenia, handgrip strength, and gait speed with cognitive function. The relationship of depressive symptoms and cognition were also mediated by sarcopenia, handgrip strength, and gait speed.

LIMITATIONS

This is a cross-sectional study.

CONCLUSIONS

Our findings suggest that sarcopenia may contribute substantially to the development of MCI in the older adults via depressive symptoms, although the reverse may also be true. These findings may help guide clinicians to better diagnose and manage MCI in the context of concomitant sarcopenia and depressive symptoms.

Muscle mass rather than muscle strength or physical performance is associated with metabolic syndrome in community-dwelling older Chinese adults

OBJECTIVE

The purpose of this study was to examine whether muscle mass, muscle strength, and physical performance were associated with metabolic syndrome (MetS) in community-dwelling older Chinese adults.

METHODS

The study comprised of 1413 community-dwelling Chinese participants (577 men; mean ± standard deviation age: 71.3 ± 5.9) recruited from Tianjin and Shanghai, China who were invited to participate in a comprehensive geriatric assessment. The International Diabetes Federation metabolic syndrome guidelines were used to define MetS, including high waist circumference, elevated blood pressure, elevated fasting blood glucose, elevated triglycerides, and reduced HDL cholesterol. Muscle mass was measured by appendicular skeletal muscle mass/weight (ASM/weight), and ASM was measured by BIA. Muscle strength was measured using grip strength. Physical performance was represented by walking speed and the time up and go test (TUGT).

RESULTS

The overall prevalence of MetS was 46.8% (34.1% in males and 55.5% in females). In the final logistic regression model, there was a significant, graded inverse association between muscle mass and MetS (p for trend = 0.014). Muscle strength and physical performance, including walking speed and TUGT, were not associated with overall MetS. In the components of MetS, muscle mass and grip strength were significantly inversely associated with high waist circumference and elevated blood pressure (p < 0.05), while physical performance was not associated with components of MetS.

CONCLUSIONS

Compared with muscle strength and muscle function, muscle mass was inversely associated with MetS in a community-dwelling elderly Chinese population. Among muscle mass、muscle strength and physical performance, muscle mass appears to have the strongest association with MetS in the elderly.

[COⅠ and 16S rDNA Sequence Identification of Common Necrophagous Flies in Fujian Province]

Abstract

Objective To identify the species of common necrophagous flies in Fujian Province by gene fragment sequences of mitochondrial cytochrome c oxidase subunit Ⅰ （COⅠ） and 16S ribosomal deoxyribonucleic acid （16S rDNA）, and to explore the identification efficacy of these two molecular markers. Methods In total 22 common necrophagous flies were collected from the death scenes in 9 different regions in Fujian Province and DNA was extracted from the flies after morphological identification. The gene fragments of COⅠ and 16S rDNA were amplified and sequenced. All the sequences were uploaded to GeneBank and BLAST and MEGA 10.0 software were used to perform sequence alignment, homology analysis and intraspecific and interspecific genetic distance analysis. The phylogenetic trees of DNA fragment sequences of COⅠ and 16S rDNA of common necrophagous flies in Fujian Province were established by unweighted pair-group method with arithmetic means （UPGMA）, respectively. Results The flies were classified into 6 species, 5 genera and 3 families by morphological identification. The results of gene sequence analysis showed that the average number of interspecific and intraspecific genetic distance of 16S rDNA ranged from 1.8% to 8.9% and 0.0% to 2.4%, respectively. The average number of interspecific and intraspecific genetic distance of COⅠ ranged from 7.2% to 13.6% and 0.0% to 6.3%, respectively. Conclusion The gene sequences of COⅠ and 16S rDNA can accurately identify the species of different necrophagous flies, and 16S rDNA showed higher value in species identification of common calliphoridae necrophagous flies in Fujian Province.

Concomitant botanical medicine use among patients participating in commercial prostate cancer trials

OBJECTIVES

Patients with cancer frequently use botanical medications. The concomitant use of such medications by patients on commercial trials has not been well-described, despite the importance of these trials for evaluating the safety and efficacy of new agents. We sought to describe the use of botanical medications taken by patients with prostate cancer enrolled on global commercial trials.

DESIGN

Retrospective study.

SETTING

Regulatory repository of commercial clinical trial data.

INTERVENTIONS

Anti-cancer therapy.

MAIN OUTCOME MEASURES

Botanical and medication use data were pooled across six international commercial randomized trials for metastatic prostate cancer with detailed information on medication and indications. Botanical products were considered to have potential for drug interaction if they led to a change in drug exposure in human trials. Potential for interaction was ascertained by PubMed review. Descriptive statistics were used for analysis.

RESULTS

Of 7318 enrolled patients, 700 (10 %) reported botanical use at any time and 653 (9%) reported use of botanical products while on trial. Nearly half of botanical product types were not classified by plant (43 %). The highest proportion of botanical use was among patients in Asian countries (32 %), followed by patients in North America (13 %). Eighty-six different types of botanical products were used; of these, nineteen had a patient-reported anti-cancer indication.

CONCLUSIONS

Botanical medicine use among patients with prostate cancer in commercial trials is moderate, although it varies by region. Practitioners should be aware of the use of botanical interventions in a clinical trial context.

Blockage of PAK1 alleviates the proliferation and invasion of NSCLC cells via inhibiting ERK and AKT signaling activity

PURPOSE

P21-activated kinase 1 (PAK1), a serine/threonine protein kinase which functions downstream of RAC and CDC42 GTPase, is activated by a variety of stimuli, including RAS and other growth signaling factors. The extracellular signal kinase (ERK) and protein kinase B (AKT) signal pathways have been implicated in the pathogenesis of cancers. Whether PAK1 is sensitive to KRAS mutation signals and plays a role through ERK and AKT signaling pathways in NSCLC needs to be studied.

METHODS

The expression of PAK1, ERK and AKT was detected in both lung cancer cell lines and clinical samples. PAK1 RNA interference and specific inhibitor of PAK1(IPA-3) were applied to lung cancer cell lines and mouse xenograft tumors. Cell growth was measured by MTT and colony formation assays. Cell migration and invasion were detected by wound healing and transwell assays. RAS mutation was detected by Taqman probe method. Correlation between KRAS, PAK1, ERK and AKT activities was analyzed in lung cancer patients.

RESULTS

PAK1 was highly expressed not only in RAS mutant but also in RAS wild-type lung cancer cells. Using specific inhibitor of PAK1, IPA-3 and PAK1 RNA interference, cell proliferation, migration and invasion of lung cancer cells were reduced significantly, accompanied by decreased activities of ERK and AKT. Dual inhibition of ERK and AKT suppressed these cellular processes to levels comparable to those achieved by reduction in PAK1 expression. In NSCLC patients, PAK1 was not correlated with KRAS mutation but was significantly positively correlated with pERK and pAKT.

CONCLUSION

PAK1 played roles in NSCLC proliferation and invasion via ERK and AKT signaling and suggested a therapeutic target for NSCLC.

[Treatment and prognostic analysis of patients with primary esophageal small-cell carcinoma]

Objective: The study aimed to analyze the clinicopathological features, treatment, and prognosis factors of primary esophageal small-cell carcinoma (PESC). Methods: The clinical records and follow-up data of 100 patients with PESC were collected, and the clinicopathological features and treatments were examined. Log-rank test and Cox regression model were performed to identify the independent prognostic factors. Results: Progressive dysphagia, weight loss, and abdominal pain were the most common initial symptoms in the 100 patients with PESC. The primary tumor site mainly occurred in the middle of the chest (51%, 51/100), and the ulcer type was the most common under gastroscope (31%, 31/100). One or more positive markers of epithelial origin were present in all of the enrolled patients. At the time of diagnosis, 80 cases had limited disease (LD) and 20 cases had extensive disease (ED). The 1-, 3-, and 5-year survival rates of PESC patients were 57.0%, 18.0%, and 11.0%, respectively, with a median survival time (MST) of 13.8 months. In all PESC patients, multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length (OR=2.661, P<0.001), TNM staging (OR=1.464, P=0.016), and treatment methods (OR=0.333, P<0.001). Besides, in patients with LD, the lesion length (OR=2.638, P=0.001) and treatment methods (OR=0.285, P<0.001) were independent prognostic factors. The MST of patients in surgery + chemotherapy group (21.6 months) was longer than that of the surgery only group (8.3 months, P=0.021), while patients in surgery+ chemotherapy+ radiotherapy group were also associated with a longer MST than the chemotherapy + radiotherapy group (31.0 months, 9.8 months, respectively; P<0.001). Conclusions: PESC is a rare esophageal malignant tumor with poor prognosis. Our findings reveal that the lesion length, TNM staging, and treatment method are independent prognostic factors for PESC patients. Moreover, surgery-based comprehensive treatments may prolong the survival of patients with LD.

Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study

Objective

Osteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese.

Methods

This study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis.

Results

In total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis.

Conclusion

Our results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.

[The clinical characteristics and surgical management of ciliated muconodular papillary tumor]

Objective: To investigate the clinical characteristics and surgical management based on the clinical manifestation, pathological feature and the medical imaging finding of ciliated muconodular papillary tumor (CMPT). Methods: The data of clinical manifestation, pathological feature and the medical imaging finding of 15 patients with CMPT who received surgical treatment from January 2017 to April 2019 were collected and retrospectively analyzed. Results: CMPT generally occurred in the elderly people. Most of the diameter of the tumor was less than 1 cm, while the diameters of other 3 patient were 1~2 cm. The computed tomography (CT) scan of 9 patients displayed solid nodule, while 4 displayed ground glass opacity (GGO), and other 2 showed no significant abnormal. Thirteen patients received minimally invasive video-assisted thoracoscopic surgery (VATS), the other 2 received open surgery. Eight patients received lobectomy, 3 received thoracoscopic anatomical partial-lobectomy, 4 received wedge resection. The frozen section diagnostic results of 8 patients were adenocarcinoma, including 3 mucinous adenocarcinoma. Other 5 patients were diagnosed as CMPT and 2 were reported as infection nodule. During the perioperative period, 2 patients occurred cardiac arrhythmia, 1 occurred pulmonary infection. None of the patients had local recurrence or distant metastasis during the follow-up. Conclusions: CMPT usually presents as solitary peripheral lung nodules without obvious symptoms. Most CMPTs are incidentally detected by routine CT scan. Some of the cases are accompanied by primary lung cancer probably. Surgical treatment is the major therapy for CMPT. The imaging feature of CT scam usually shows a solid nodule or a GGO locates in peripheral pulmonary. Frozen section diagnosis for CMPTs can be easily confused with adenocarcinoma or mucinous adenocarcinoma.

Combined Depression and Malnutrition As an Effective Predictor of First Fall Onset in a Chinese Community-Dwelling Population: A 2-Year Prospective Cohort Study

This study aims to explore the single and joint effects of depression and malnutrition on the incidence of first fall onset in a Chinese community-dwelling elderly population. This cohort study consisted of 739 residents without a history of falls who were aged 60 years and older (mean age: 67.08 ± 5.79 years, female: 58.2%). Depression was defined with the Geriatric Depression Scale (GDS)-30; a score of ≥11 was considered to be depressed, while malnutrition was defined with the Mini Nutritional Assessment where a score <17 was defined as malnourished. Over a 2-year follow-up period, older adults who experienced at least one fall were allocated to the first fall onset group. The prevalence of baseline falls was 21.36%. During the 2-year follow-up, incidence of first fall onset was 13.13%. After adjusting for all confounders, depression alone (adjusted odds ratio [OR] = 3.545, 95% confidence interval [CI] = 1.318-9.535) and malnutrition alone (adjusted OR = 2.204, 95% CI = 1.183-4.108) were observed to be independent risk factors for first fall onset, while comorbidity of depression and malnutrition showed progressively increased risk of promoting first fall (adjusted OR = 8.161, 95% CI = 3.591-18.545) than those with only depression or malnutrition or without both depression and malnutrition. Malnutrition mediated 56% effects in the association between depression and first fall onset, while depression mediated 76% effects in the promoting role of malnutrition in first fall. Depression and malnutrition were found to be independent causes for promoting first fall, while mental health and nutrition should be treated as commonly prior interventions to delay first fall onset. Meanwhile, for malnourished Chinese community-dwelling older adults, avoidance or treatment of depression should be addressed at first.

Parasitological and molecular detection of human fascioliasis in a young man from Guizhou, China

A 24-year-old man born in Guizhou province was diagnosed with obstructive jaundice and bile duct stones in 2013. Four living trematodes were found during laparotomy and cholecystectomy. Based on the morphology and molecular genetics analysis of internal transcribed spacer and pcox1 genes of the flatworm specimens, the trematodes from the patient were confirmed to be Fasciola hepatica. This report provided the clinical and molecular diagnosis information on human fascioliasis, which is an emerging sanitary problem still ignored in China. Human fascioliasis constantly occurs due to climatic changes and frequency of human travel. Therefore, it deserves more attention from physicians working in both developing and developed countries.

MR Diffusional Kurtosis Imaging-Based Assessment of Brain Microstructural Changes in Patients with Moyamoya Disease before and after Revascularization

BACKGROUND AND PURPOSE

Conventional imaging examinations are insufficient to accurately assess brain damage in patients with Moyamoya disease. Our aim was to observe brain microstructural changes in patients with Moyamoya disease by diffusional kurtosis imaging and provide support data for application of this technique in individualized assessment of disease severity and surgical outcome among patients with Moyamoya disease.

MATERIALS AND METHODS

A total of 64 patients with Moyamoya disease and 15 healthy volunteers underwent diffusional kurtosis imaging, and a second scanning was offered to surgical patients 3-4 months after revascularization. The diffusional kurtosis imaging parameter maps were obtained for mean kurtosis, axial kurtosis, radial kurtosis, fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. The parameter values were measured in sensory pathway-related regions for all subjects. Differences in diffusional kurtosis imaging parameters of these brain regions were examined for healthy volunteers, patients without acroparesthesia, and asymptomatic and symptomatic sides of patients with acroparesthesia. Changes in diffusional kurtosis imaging parameters of patients with Moyamoya disease before and after revascularization were compared.

RESULTS

Compared with healthy volunteers, patients with Moyamoya disease showed decreased mean kurtosis, axial kurtosis, radial kurtosis, and fractional anisotropy in the corona radiata. Similarly, mean kurtosis, radial kurtosis, and fractional anisotropy decreased in the posterior limb of the internal capsule, whereas axial kurtosis decreased and radial kurtosis increased in the thalami of patients with Moyamoya disease compared with healthy volunteers. Compared with the asymptomatic contralateral hemisphere, the symptomatic group showed increased mean kurtosis in the contralateral primary somatosensory cortex, increased fractional anisotropy in the contralateral corona radiata and posterior limb of the internal capsule, and decreased axial kurtosis in the contralateral thalamus. Among patients with Moyamoya disease with acroparesthesia, mean kurtosis decreased in the primary somatosensory cortex on the operated side following revascularization.

CONCLUSIONS

The diffusional kurtosis imaging technique is applicable to patients with Moyamoya disease for detecting brain microstructural changes in white and gray matter before and after revascularization; this feature is useful in the assessment of disease severity and surgical outcome.

[The influence of TP53 mutation on the therapeutic effect of EGFR tyrosine kinase inhibitor and prognosis of EGFR mutant non-small cell lung cancer patients]

Gene mutations can impair the sensitivity of cancer cells to targeted drugs, and lead to individual differences of clinical therapeutic effects. Epidermal growth factor receptor (EGFR) mutation plays an important role in therapeutic decision-making. Furthermore, some co-existing gene mutations, such as TP53 mutation, can also affect the therapeutic effect and prognosis of patients. Whether EGFR mutation combined with TP53 mutation affects the sensitivity of lung cancer cells to tyrosine kinase inhibitor (TKI) and long-term prognosis of non-small cell lung cancer (NSCLC) patients is still unknown and has attracted more attentions. However, in the current clinical practice, TP53 mutation is not a key factor of therapeutic decision-making, so further studies are needed to clarify the impact of TP53 mutation (including each subtype) on the potential benefits of EGFR-targeted therapy of NSCLC.

Clinical relevance of different handgrip strength indexes and metabolic syndrome in Chinese community-dwelling elderly individuals

PURPOSE

Currently there is no consensus on the correlation between metabolic syndrome (MetS) and muscle strength. The objective of this study was to examine the associations between MetS and its components and different handgrip strength (HS) indexes among Chinese community-dwelling elderly individuals. In addition, we hoped to find an optimal cutoff point for the index most relevant to MetS.

METHODS

Data were obtained from 909 participants aged ≥ 60 years (385 men, average age, 68.0 ± 5.9 y). We used the International Diabetes Federation metabolic syndrome guidelines to define MetS. General data of all participants were collected through questionnaires and anthropometric data were measured. At the same time, blood samples were collected.

RESULTS

The prevalence of MetS was 26.8 % in men and 46.9 % in women. In all HS indexes, HS/body fat mass was most strongly correlated with MetS, and the areas under the receiver-operating characteristic curve were 0.723 (95 % confidence interval [CI] = 0.669-0.776) in men and 0.619 (95 % CI = 0.571-0.667) in women, and the optimal cutoffs were 1.92 in men and 1.25 in women. The adjusted odds ratios (ORs) of MetS for low HS/body fat mass were 5.38 (95 % CI = 3.03-9.56, p < 0.001) in men and 2.39 (95 % CI = 1.56-3.64, p < 0.001) in women.

CONCLUSIONS

HS/body fat mass appears to be the index best associated with MetS and its components, and in men it is more relevant than in women.

Combined Effect of Osteoporosis and Poor Dynamic Balance on the Incidence of Sarcopenia in Elderly Chinese Community Suburban-Dwelling Individuals

OBJECTIVES

Given the increasing prevalence of osteoporosis and the important role dynamic balanced plays in the assessment of muscle function, we aimed to examine the joint and separate effects of osteoporosis and poor dynamic balance on the incidence of sarcopenia in Chinese elderly individuals.

DESIGN

This study was conducted on 658 (44.4% male) Chinese suburban-dwelling participants with a mean age of 68.42 ± 5.43 years who initially had no sarcopenia and were aged ≥60 years. A quantitative ultrasound scan of each participant's calcaneus with a T score less than -2.5 was used to identify the prevalence of osteoporosis. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. We assessed dynamic balance using the Timed Up and Go Test (TUGT). Participants who scored in the top 20% on the TUGT were defined as having poor dynamic balance.

RESULTS

After a follow-up of three years, the incidence of sarcopenia in the general population was 8.1% (9.6% in males, 6.8% in females). The incidence of sarcopenia was progressively greater in people suffering from both osteoporosis and poor dynamic balance (OR=2.416, 95%CI=1.124-5.195) compared to those who only had osteoporosis (OR=0.797, 95%CI=0.378-1.682) or poor dynamic balance (OR=1.226, 95%CI=0.447-3.363) in models without adjustments. Even after adjusting for potential confounders, the result still held true (OR=2.431, 95%CI=1.053-5.614).

CONCLUSIONS

In our study, we found individuals who suffered from both osteoporosis and poor dynamic balance simultaneously had a significantly higher incidence of sarcopenia than those who suffered from either one or the other.

The Predictive Value of Sarcopenia and Its Individual Criteria for Cardiovascular and All-Cause Mortality in Suburb-dwelling Older Chinese

OBJECTIVES

The aim of the present study is to investigate the associations between the Asian Working Group for Sarcopenia (AWGS) sarcopenic definition, and its individual criteria, and risk of cardiovascular disease (CVD) and all-cause mortality in the Chinese elderly.

METHODS

Longitudinal analysis of 1,264 participants aged 60 years or older at baseline (2013-2014) living in suburban areas, China. Sarcopenia was defined according to the recommended algorithm of AWGS. Muscle mass was measured by a direct segmental multifrequency bioelectrical impedance analysis. Muscle strength was assessed by handgrip strength, and physical performance measured via usual walking speed.

RESULTS

Cox proportional hazard models were used to assess the risk of CVD and all-cause mortality. After 40 months of follow-up, forty-eight deaths (4.2%) died in this cohort. The mortality rate with sarcopenia was 4.7% in men and 3.8% in women. After adjusting for potential confounders, the risk of all-cause death was 4.15 times higher in subjects with sarcopenia. Furthermore, low muscle mass (HR: 2.62, 95% CI 1.34-5.13) and low grip strength (HR: 5.79; 95% CI 2.28-14.71), but not walking speed, were found to be significantly associated with all-cause mortality. Risk of CVD mortality was significantly greater in sarcopenia. Low grip strength and low walking speed were associated with 11 times (HR: 11.03, 95% CI 1.58-77.02) and 13 times (HR: 13.02; 95% CI 1.18-143.78) higher risk of CVD mortality.

CONCLUSIONS

Sarcopenia and components of sarcopenia were associated with greater CVD and all-cause mortality. Pertinent prevention or rehabilitation programs projects should look to promote healthy aging in different types of sarcopenia group.

Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report

A 34-year-old woman presented with a progressive oral ulcer, and redness and swelling of the skin over the mandible. Radiological and histological examination showed adenoid cystic carcinoma of the mandible and floor of the mouth with extensive invasion. We radically resected the tumour with sufficient margins, and cut off segments of fibula, reshaped them and fixed them into the mandibular angles bilaterally. We used three perforator flaps, (the soleus muscle, the third, and fourth perforator flaps) to reconstruct the defects of the tongue, mentum, and oral floor, respectively. Recovery was good postoperatively, and there was no infection or any other complications.